Ankylosing Spondylitis

Ankylosing Spondylitis

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Arthritis affecting the spine is called ankylosing spondylitis or AS. It is a systemic disease affecting tissues and joints throughout the body. There is inflammation of the spinal cord or vertebrae, leading to severe, chronic pain. Advanced disease state is called ankyloses, where a new bone is formed in the spine. This causes parts of the spine to fuse and leads to immobility. Sacroiliac (SI) joints, located at the base of the spine where the sacrum meets the iliac bones of the pelvis, are also involved during the progression of the disease.

AS is the backbone for the whole human body and hence inflammation, pain, and stiffness of the spinal cord leads to pain and stiffness in the shoulders, hips, ribs, heels, and small joints of the hands and feet. AS is often observed in men than in women. It is also more common in children and is termed as juvenile AS in them.There are different types of spondylitis such as ankylosing spondylitis, enteropathic arthritis, psoriatic arthritis, reactive arthritis, undifferentiated spondyloarthritis, and juvenile spondyloarthritis.

Physiology of AS
AS cause is not well understood, but the pathogenesis is associated with genetic condition by HLA-B27 gene. Person suffering from AS have this gene in them but that only does not confirm that they will acquire AS. It’s a complex interaction between immune system, inflammation and HLA-B27 gene. Inflamed enthesis (Entheseal Fibrocartilage) in the vertebrae is the major target in AS, also in combination with inflammation in synovium. Myxoid subchondral bone marrow is also get affected.

What are the Symptoms of AS
Spondylitis often starts around the sacroiliac joints leading to persistent pain and stiffness in the low back, hips, and buttocks. This pain lasts for more than 3 months. Spondylitis affects some of the ligaments and tendons too.

AS causes the bones to overgrow leading to abnormal joining of bones called bony fusion. This affects the person's ability to perform routine activities. Taking a deep breath is even affected due to the fusion of ribs to the spine or breastbone.

People having AS may also have fever, fatigue, and loss of appetite. Eye inflammation, lung and heart problems also occur in such cases.

How is AS Diagnosed?
The diagnosis of AS is based on evaluating the patient's symptoms.Physical examination, X-ray, and blood tests are generally used to diagnose AS.

The examination observes signs of inflammation and decreased movement of joints. Flexibility of the low back and neck is decreased. Tenderness of the sacroiliac joints of the upper buttocks is noted. A stooped posture is acquired by severely affected people. Inflammation of the eyes is evaluated with an ophthalmoscope.

X-ray reveals abnormalities of the spine. A blood test called sedimentation rate is for a nonspecific marker of inflammation throughout the body, which is seen in cases of AS. Fusion up and down the spine leads to a condition called bamboo spine, which is seen on an X-ray and it leads to complete loss of mobility.

How is AS Treated?
There is no treatment for AS, though the symptoms and severity of AS can be minimized. Pain and stiffness can be reduced by trying to maintain a good posture.

Early physical and occupational therapy helps maintain function and minimize deformity. Daily exercises reduces stiffness, strengthens the muscles, and prevents the risk of disability. Swimming aids people with AS significantly.

Nonsteroidal anti-inflammatory drugs are the most common drugs used in the treatment of AS.

Stem Cell Treatment for AS
Studies have showed that, when MSCs were infused, there was pain relief and the scores assessing AS activity and severity reduced. Most patients were able to exercise post transfusion of the MSCs. ESR and CRP levels returned to normal, which indicated reduced AS activity and inhibition of inflammation.